Acromegaly

Question 1

What is acromegaly?

Answer 1

1. A multisystem disorder characterised by excessive growth hormone from the anterior pituitary gland
2. • Large hands and feet
   • Parasthesia (due to carpal tunnel syndrome)
   • Macroglossia / Interdental septation / Strong jaw
   • Obstructive sleep apnoea
   • Polyuria / polydypsia (diabetes)
   • Visual defects (bitemporal hemianopia)
   • Frontal bossing, headaches
   • Polyarthalgia

Question 2

What is the childhood version of Acromegaly?

Answer 2

Giantism

Question 3

5% of Acromegaly are associated with which genetic condition?

Answer 3

MEN1 syndrome

Question 4

What is the first-line diagnostic test for Acromegaly? What are other tests?

Answer 4

• Insulin-like growth factor 1 - first line

Other tests:

• GH measurements after glucose tolerance (should normally decrease)
• Serum prolactin (may increase in 20% cases)
• MRI pituitary gland
• 12-Lead ECG for cardiomyopathy
• Visual field testing

Question 5

What are the treatments for Acromegaly?

Answer 5

• Transphenoidal surgery (first-line)
• Dopa agonists i.e. Cabergoline, Bromocriptine
• Somatostatin analogue i.e. Octreotide
• GH receptor antagonist i.e. Pegvisomant

Question 6

What is the pathophysiology of acromegaly?

Answer 6

Somatotroph adenoma of pituitary gland or..
- Ectopic secretion in lungs / pancreas of..

Pulsatile secretion of growth hormone -> acts on Insulin-like growth factor 1 which regulates cell division / cell apoptosis

Question 7

What are symptoms of acromegaly?

Answer 7

• Large hands and feet
• Parasthesia (due to carpal tunnel syndrome)
• Macroglossia / Interdental septation / Strong jaw
• Obstructive sleep apnoea
• Polyuria / polydypsia (diabetes)
• Visual defects (bitemporal hemianopia)
• Frontal bossing, headaches
• Polyarthalgia